CTICasesAirway-Invasive Aspergillus Bronchiolitis from Marijuana Smoking in a Heart Transplant Recipient
Imaging findings
In a heart transplant recipient, the current chest radiograph shows new nodules, right basal consolidation, and pleural effusion compared with a baseline study; CT shows extensive small-airways disease predominantly in the upper lungs with tree-in-bud opacities and some additional lower lobe abnormality, and bronchoscopy grew Aspergillus.
Key takeaways
This pattern of upper-lung-predominant airways bronchitis and bronchiolitis with tree-in-bud opacities reflects airway-invasive Aspergillus disease related to daily marijuana smoking, a recognized route of fungal exposure that is especially concerning in immunosuppressed transplant recipients, who are at risk for progression to more invasive disease. As marijuana use has become legal in many places, patients are less likely to volunteer this history or perceive it as a risk factor, making it important to ask specifically about marijuana use, including the delivery method such as joints, water-filtered bongs, or dabbing, since it may influence the type of pulmonary injury or infection encountered.
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